Nursing Elites

1. The nurse is planning discharge teaching for four mothers. Which postpartum client is at highest risk for psychological difficulties during the postpartum period?

• A. A primiparous woman who has recently migrated to the US with her spouse
• B. A multiparous client who lives with her husband and his family members
• C. A multiparous female with a large family living in a community
• D. A primiparous adolescent living at home with her parents and significant other

Correct answer: A

Rationale: A primiparous woman who has recently migrated to the US with her spouse is at the highest risk for psychological difficulties during the postpartum period. Recent migration and adjustment to a new environment can increase the risk of postpartum depression, especially when combined with the challenges of being a new mother. Choice B, a multiparous client living with her husband and his family, may have social support from family members, which can be protective against psychological difficulties. Choice C, a multiparous female with a large family living in a community, also indicates potential social support. Choice D, a primiparous adolescent living at home with her parents and significant other, may have a support system in place with her family and significant other.

2. Which FHR finding is the most concerning to the nurse providing care to a laboring client?

• A. Accelerations with fetal movement.
• B. Early decelerations.
• C. Average FHR of 126 beats per minute.
• D. Late decelerations.

Correct answer: D

Rationale: Late decelerations are caused by uteroplacental insufficiency, resulting in fetal hypoxemia. They are considered ominous if persistent, indicating compromised oxygen supply to the fetus. Accelerations with fetal movement (Choice A) are reassuring signs of fetal well-being. Early decelerations (Choice B) are typically benign, associated with head compression during contractions. An average FHR of 126 beats per minute (Choice C) falls within the normal range for fetal heart rate and is not concerning. Therefore, the most concerning FHR finding in a laboring client is late decelerations (Choice D).

3. Does the probability of having a child with Down’s syndrome increase with the age of the parents?

• A. TRUE
• B. FALSE
• C. Sometimes
• D. Never

Correct answer: A

Rationale: The correct answer is A: TRUE. Advanced parental age, particularly maternal age, is associated with an increased risk of Down's syndrome in offspring. As parents get older, the likelihood of having a child with Down's syndrome increases. Choices B, C, and D are incorrect because the risk of Down's syndrome is known to rise with parental age, especially maternal age, due to the increased likelihood of chromosomal abnormalities during egg formation.

4. Examination reveals that the laboring client's cervix is dilated to 2 centimeters, 70% effaced with the presenting part at -2 station. The client tells the nurse, 'I need my epidural now, this hurts.' The nurse's response to the client is based on which information?

• A. The client will need to be catheterized before the epidural can be administered.
• B. Administering an epidural at this point would slow down the labor process.
• C. The client should be dilated to at least 8 centimeters before receiving an epidural.
• D. The baby needs to be at a zero station before an epidural can be administered.

Correct answer: B

Rationale: Administering an epidural too early in labor, especially at 2 cm dilation, can slow down the progress of labor. It is usually recommended to wait until labor is more established. Choice A is incorrect because catheterization is not a prerequisite for epidural administration. Choice C is incorrect as waiting until 8 cm dilation is not a standard requirement for epidural administration. Choice D is incorrect because the baby's station being at zero is not a strict criterion for epidural administration.

5. A nurse on an antepartum unit is reviewing the medical records for four clients. Which of the following clients should the nurse assess first?

• A. A client who has diabetes mellitus and an HbA1c of 5.8%
• B. A client who has preeclampsia and a creatinine level of 1.1 mg/dL
• C. A client who has hyperemesis gravidarum and a sodium level of 110 mEq/L
• D. A client who has placenta previa and a hematocrit of 36%

Correct answer: C

Rationale: A sodium level of 110 mEq/L is critically low and can indicate severe dehydration and electrolyte imbalance, requiring immediate intervention.

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